Back to Local Coverage What's New Report Results
LCD Reference ArticleBilling and Coding Article
A52776
Expand All |Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD. Learn more
Document Note
Note History
Contractor Information
Article Information
General Information
Source Article ID
N/A
Article ID
A52776
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Therapy Students and Aides
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2017
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein. Current Dental Terminology © 2023 American Dental Association. All rights reserved. Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may becopied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes anddescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative workwithout the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes,resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions;and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyauthorized with an express license from the American Hospital Association.The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness oraccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in thepreparation of this material, or the analysis of information provided in the material. The views and/or positionspresented in the material do not necessarily represent the views of the AHA. CMS and its products and services arenot endorsed by the AHA or any of its affiliates.
CMS National Coverage Policy
N/A
Article Guidance
Article Text Coverage and documentation requirements for the provision of services by/or in the presence of a therapy student or therapy aide in both inpatient and outpatient therapy settings. Medicare coverage requirements state that rehabilitation services must be provided and/or supervised by a qualified clinician i.e., physician, non-physician practitioner (NPP), qualified physical therapist (PT), occupational therapist (OT), speech-language pathologist (SLP), or appropriately supervised/qualified therapy assistant. Inpatient SNF Setting Therapy aides cannot provide skilled services. However, the time that a therapy aide spends on set-up preceding skilled therapy may be coded on the Minimum Data Set (MDS) (e.g., set up the treatment area for wound therapy) and should be coded under the appropriate mode for the skilled therapy (individual, concurrent, or group) in O0400. The therapy aide must be under direct supervision of the therapist or assistant. Therapy Students Therapy students are not required to be in line-of-sight of the supervising therapist/assistant. The determination of whether or not a student is ready to treat patients without line-of-sight supervision is left to the discretion of the supervising therapist/assistant. Time may be coded on the MDS when the therapist provides skilled services and direction to a student who is participating in the provision of therapy. All state and professional practice guidelines for student supervision must be followed. Therapy Aides Therapy aides cannot provide skilled services. Also, unskilled service minutes provided by the therapy aide cannot be counted and are not reimbursable even when provided under direct supervision by the qualified therapist or assistant e.g. Therapy Students Services provided by therapy students are not reimbursable even if provided under direct supervision of the therapist/assistant. However, when a student is in the room, the time that a qualified clinician spends with the patient is reimbursable when the medical record supports: When a therapy student is involved the skilled minutes of the qualified clinician may be counted and coded when all requirements listed above are met. For additional information, see the attached article "Medical Necessity of Therapy Services" in the Related Local Coverage Documents link below. Sources
Therapy Aides
Outpatient Therapy Setting
Response To Comments
| Number | Comment | Response |
|---|---|---|
| 1 |
N/A
Coding Information
Bill Type Codes
| Code | Description |
|---|
N/A
Revenue Codes
| Code | Description |
|---|
N/A
CPT/HCPCS Codes
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
CPT/HCPCS Modifiers
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
ICD-10-CM Codes that Support Medical Necessity
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
ICD-10-CM Codes that DO NOT Support Medical Necessity
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
ICD-10-PCS Codes
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
Additional ICD-10 Information
N/A
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.
| Code | Description |
|---|
N/A
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
| Code | Description |
|---|
N/A
Other Coding Information
Expand All |Collapse All
Group 1
Group 1 Paragraph N/A
N/A
N/A
Coding Table Information
Excluded CPT/HCPCS Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| N/A | N/A |
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|
N/A
Revision History Information
| Revision History Date | Revision History Number | Revision History Explanation |
|---|---|---|
| 01/01/2017 | R5 | Updated to indicate this article is not an LCD reference article. |
| 01/01/2017 | R4 | Article revision made to clarify which part pertains to Part A and to Part B services. No change in coverage was made. |
| 01/01/2017 | R3 | Article converted to Billing and Coding, no other changes were made |
| 01/01/2017 | R2 | This article now combines JFA A52763 into the JFB article A52776 so that both JFA and JFB contract numbers will have the same final MCD article number as JFB A52776. |
| 10/01/2015 | R1 | The wording in this article was updated; however, coverage guidance did not change. |
N/A
Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
Articles
A52775 - Billing and Coding: Medical Necessity of Therapy Services
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
| Updated On | Effective Dates | Status | |
|---|---|---|---|
| 11/14/2023 | 01/01/2017 - N/A | Currently in Effect | You are here |
| 10/28/2020 | 01/01/2017 - N/A | Superseded | View |
| 09/29/2020 | 01/01/2017 - N/A | Superseded | View |
| 12/21/2016 | 01/01/2017 - N/A | Superseded | View |
| Some older versions have been archived. Please visit theMCD Archive Site to retrieve them. | |||
Keywords
N/A
Read the Article Disclaimer
Email this document to yourself or someone else
An asterisk (*) indicates arequired field. This email will be sent from you to therecipient email address(es) you enter. Please do not use this feature to contact CMS.To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottomof every MCD page.
Code Range
Contractor Detail
Article Disclaimer
The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare,Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administrationof the Medicare program. Medicare contractors are required to develop and disseminate Articles. CMS believes that the Internet isan effective method to share Articles that Medicare contractors develop. While every effort has been made to provide accurate andcomplete information, CMS does not guarantee that there are no errors in the information displayed on this web site. THE UNITED STATESGOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSESDISCLOSED HEREIN. Neither the United States Government nor its employees represent that use of such information, product, or processeswill not infringe on privately owned rights. In no event shall CMS be liable for direct, indirect, special, incidental, or consequentialdamages arising out of the use of such information, product, or process.
LCD Reference Article
Articles are a type of document published by the Medicare Administrative Contractors (MACs). Articles often contain coding or other guidelines and may or may not be in support of a Local Coverage Determination (LCD).
Articles identified as “Not an LCD Reference Article” are articles that do not directly support a Local Coverage Determination (LCD). They do not include a citation of an LCD. An example would include, but is not limited to, the Self-Administered Drug (SAD) Exclusion List Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.
Articles which directly support an LCD are known as “LCD Reference Articles”. The referenced LCD may be cited in the Article Text field and may also be linked to in the Related Documents field. Examples may include but are not limited to Response to Comments and some Billing and Coding Articles. If you have a question about this kind of article, please contact the MAC listed within the Contractor Information section of the article.
License Agreements
Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes.
LICENSE FOR USE OF PHYSICIANS' CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT")
End User Point and Click Amendment:
CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the American Medical Association (AMA).
You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885.Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt.
Applicable FARS\DFARS Restrictions Apply to Government Use.
AMA Disclaimer of Warranties and Liabilities.
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsem*nt by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
CMS Disclaimer
The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled "I Accept".
LICENSE FOR USE OF CURRENT DENTAL TERMINOLOGY (CDTTM)
End User License Agreement:
These materials contain Current Dental Terminology (CDTTM), copyright© 2023 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement.
If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen.
If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting.
- Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
- Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site,http://www.ADA.org.
- Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use.U.S. Government Rights Provisions.
- Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license.
- ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for software, including any CDT and other content contained therein, is with CMS; and no endorsem*nt by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement.
The ADA is a third party beneficiary to this Agreement.
- CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS disclaims responsibility for any liability attributable to end user use of the CDT. CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.
The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I Accept". If you do not agree to the terms and conditions, you may not access or use software. Instead you must click below on the button labeled "I Do Not Accept" and exit from this computer screen.
LICENSE FOR NATIONAL UNIFORM BILLING COMMITTEE (NUBC)
American Hospital Association Disclaimer
The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
Submit Feedback/Ask a Question
